Primary objective: The purpose of this review is to assess whether information available to evaluate the impact of the environment and, more specifically, socio-economic factors on height in European countries is sufficient.
Main outcomes and results: It is proposed that studies based on measurements taken 25 years ago or more are unsatisfactory for assessing the current situation. There is a widespread assumption that sufficient information is available for assessing the issue. However, on inspection, there are very few environmental factors for which sufficient material on their effects on height has been published. In many studies to evaluate the effect of the environment an ecological design is used and a post hoc interpretation is made. It is concluded that this type of study is helpful only for generating hypotheses. When inspecting analytical studies on the association between socio-economic factors and height it is observed that the reports identified are only the tip of the iceberg of published reports on the subject and include studies from less than half the European countries. In many of these papers the independent variables are not defined in the same manner and a formal comparison is difficult to make.
Conclusions: Given the current deficiencies, it is worthwhile to discuss in auxological epidemiology whether it is relevant to tackle the issue proposed in this review. If the answer is yes, it is necessary to identify the best course of action. Possible avenues to explore are the potential and the barriers for harmonizing the investigation of socio-economic factors in growth studies, and the organization of a registry of reports on growth and social factors. At a more modest level, a collaborative report examining the availability of information and gaps on this topic among European countries could be helpful.